Pain Management Agreement Sample

Treatment of chronic pain with opioids is complex and difficult. Physicians need to know if patients can follow the treatment plan, whether they are receiving the desired drug responses, and whether there are signs of developing addiction. And patients need to be aware of the potential risks of opioids, as well as expectations to minimize these risks. Doctors use “medication contracts” to ensure that the patient and provider are on the same site prior to the start of opioid therapy. Such agreements are most commonly used when narcotic painkillers are prescribed. If the contract is terminated, I will not be a dr. patient and will urgently consider a treatment of chemical dependence if they are clinically indexed. My treatment program may be modified because of the results of treatment, especially if the painkillers are ineffective. These drugs are stopped. My treatment plan includes: If your doctor asks you to sign a pain treatment agreement, discuss any concerns you may have with the doctor before signing the contract. Questions you want to ask include: A pain management agreement may contain statements such as those listed in the sample document below.

I understand that I am entitled to complete pain management. I would like to conclude a treatment agreement to avoid possible chemical dependence. I understand that not following one of these instructions may result in the fact that Dr. `O` does not provide me with ongoing care. I, my diagnosis is – I agree with the following assertions: The application of a pain management pact helps to document the understanding between doctor and patient. Such documentation, when used as a means of facilitating care, can improve communication between physicians and patients. I do not accept prescription prescriptions from another doctor. I will be responsible for making sure that I am not short of medication on weekends and holidays, as a sudden discontinuation of these medications can result in severe withdrawal syndrome. I understand I have to keep my meds in a safe place. I understand that Dr. ` will not provide additional supplements for prescribing medications that I may lose. If my medication is stolen, dr.

– will only fill the prescription once if a copy of the theft`s police report is forwarded to the doctor`s office. I will not give my recipes to anyone else. I only use a pharmacy. I will keep my scheduled appointments with dr. – unless I announce the cancellation 24 hours in advance. I agree to refrain from any “mind/mood”/illicit/addictive changes, including alcohol, unless this has been approved by Dr. I understand that Dr. – believe in the following “Bill of Rights Pain Patients.” Drugs – American Academy of Pain Management: “Opioid Agreements – Contracts.” ..

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